Primary care physicians have traditionally made patient referrals based on personal knowledge and individual preference. Typically, a primary care physician will rely on his or her own personal knowledge, however limited and/or inaccurate, of specialists when deciding to whom to refer a particular patient. Referrals are an important source of patients, and thus revenues, for many medical practices. Thus, for many health care organizations, such as Health (Hospital) Systems or Accountable Care Organizations, there is a financial interest in preventing patient referrals to providers outside of the organization, and to increasing referrals coming into the organization. Out-migration of patients from hospital systems and other healthcare networks, i.e. away from their employed and/or contracted physicians, can result in millions of dollars in lost revenue every year.
Changes in the primary care landscape, including growing patient volume and the increasing primacy of insurance coverage, may cause complications to the traditional methods of making patient referrals. Moreover, recent changes in the economics of providing healthcare (i.e., decreased revenues generated on a per patient basis) may require that primary care practices and specialists increase productivity in order to prevent lost revenues.
Currently, some limited electronic referral systems exist. However, such systems often require the owner of the record to populate the information of their referring partners (name, phone, fax, etc.), are specific to a particular electronic medical record or technology platform and are geographically limited. Moreover, the data included in such systems is often limited to publicly or commercially available data.
The currently available referral systems and techniques are inefficient, as the referring practices' staff often must contend with multiple, complex and cumbersome processes for finding the right specialists and making referrals. Such referral processes take a significant amount of time and limit the focus on patient care quality. Furthermore, such systems make referrals without knowledge of insurance data.
Thus, a heretofore unaddressed need exists in the industry to address the aforementioned deficiencies and inadequacies.